Acute gastric dilatation

　　1, Surgical trauma, anesthesia, and surgery, especially abdominal and pelvic surgery and vagotomy, can directly stimulate somatic or visceral nerves, causing autonomic nervous dysfunction of the stomach, reflex inhibition of the gastric wall, resulting in relaxation of gastric smooth muscle, and eventually leading to dilatation. Tracheal intubation during anesthesia, and oxygen and nasogastric feeding after surgery, can also cause a large amount of gas to enter the stomach, forming dilatation.

　　2, Gastrointestinal volvulus, incarcerated hiatal hernia, and duodenal obstruction due to various causes, such as duodenal tumor, foreign bodies, and others, can cause gastric retention and acute gastric dilatation; lesions near the pylorus, such as spinal deformities, annular pancreas, and pancreatic cancer, can occasionally compress the gastric outlet and cause acute gastric dilatation; the so-called 'cast syndrome' caused by the application of a plaster cast on the body for 1 to 2 days may be the result of excessive extension of the spine and compression of the duodenum by the superior mesenteric artery; emotional tension, depression, and malnutrition can all cause autonomic nervous system dysfunction, leading to decreased gastric tone and delayed emptying; diabetic neuropathy, the use of anticholinergic drugs; water and electrolyte metabolic disorders, severe infections (such as sepsis) can all affect gastric tone and gastric emptying, leading to acute gastric dilatation.

　　3. Stress states caused by various injuries, especially abdominal contusions or severe multiple injuries, are related to strong stimulation of the celiac plexus.

　　This disease can cause acute gastric perforation and acute peritonitis due to necrosis of the gastric wall.

　　When the gastric dilatation reaches a certain degree, the muscle tension of the gastric wall decreases, forming a sharp angle between the esophagus and the cardia, the stomach and the duodenum, which hinders the excretion of gastric contents. The dilated stomach can compress the duodenum and push the mesentery and small intestine into the pelvic cavity. Therefore, stretching the superior mesenteric artery and compressing the duodenum at the distal end of the pylorus can cause obstruction. Increased secretion of saliva, gastric duodenal juice, pancreatic juice, and intestinal juice can accumulate a large amount of fluid in the stomach, aggravating gastric dilatation. The dilated stomach can also mechanically compress the portal vein, causing blood stasis in the abdominal viscera, and can also compress the inferior vena cava, reducing the return blood volume, which can eventually lead to peripheral circulatory failure. Due to excessive vomiting, fasting, and gastrointestinal decompression drainage, water and electrolyte imbalance can occur.

　　The symptoms do not alleviate after vomiting. With the progression of the disease, the overall condition of the body worsens progressively. Severe cases may present with dehydration, alkalosis, and symptoms such as restlessness, rapid breathing, convulsions of the limbs, decreased blood pressure, and shock. The prominent sign is distension of the upper abdomen, visible gastric contour without peristalsis, local tenderness, hyperresonance on percussion, tympany, a localized mass in the right upper umbilical region, which is prominent, smooth, elastic, slightly tender, and the lower right boundary is relatively clear. This is an extremely dilated antrum, known as 'giant antrum syndrome', which is a unique and important sign of acute gastric dilatation and can serve as a strong evidence for clinical diagnosis.

　　This disease can cause acute gastric perforation and acute peritonitis due to necrosis of the gastric wall.

　　Laboratory examination can detect blood concentration, hypokalemia, hypochloremia, and alkalosis. The upright abdominal X-ray film shows a large liquid plane in the upper left abdomen, a large gastric shadow filling the abdominal cavity, and elevation of the left diaphragm.

　　Enhance preventive measures to prevent the occurrence. According to the analysis of the pathogenesis, the important causes of this condition are vagus nerve transection and partial gastrectomy, and factors such as mental factors, anemia, hypoproteinemia, and electrolyte imbalance can induce this condition. Therefore, for surgical patients with high-risk factors, the nutritional status of the patients should be comprehensively improved during the perioperative period, and anemia should be corrected in a timely manner before and after surgery if there is gastrointestinal bleeding. To prevent its occurrence, the patient's anxiety and concerns about the illness should be alleviated, and if necessary, gastroenteric decompression should be performed before surgery to promote the recovery of intestinal peristalsis as early as possible, which can usually prevent its occurrence. Adding pyloroplasty to the subtotal gastrectomy can help prevent this condition.

　　1, Blood Routine

　　The total white blood cell count is usually not high, but after gastric perforation, the white blood cell count can increase significantly and there is leftward shift of the nucleus. Due to the loss of a large amount of body fluid, blood becomes concentrated, so hemoglobin and red blood cell count increase.

　　2, Serum Electrolytes

　　Blood potassium, sodium, and chloride levels are low.

　　3, Blood Gas Analysis

　　Severe alkalosis can be found, and the carbon dioxide binding power can increase.

　　4, Blood Biochemistry

　　Non-protein nitrogen increases.

　　5, Urinalysis

　　Increased urine specific gravity, protein and casts may appear.

　　6, Abdominal Ultrasound

　　It can be seen that there is gastric dilatation, the stomach wall becomes thin, and if there is a large amount of fluid retention in the stomach, the amount of fluid and its surface projection can be measured.

　　1, Earthworm Egg Tea

　　One live earthworm, soaked, cleaned, mashed, and mixed with one duck egg white, beaten evenly, and taken with boiling water, with the effects of clearing heat and detoxifying. It is mainly used for redness, swelling, and pain in the throat, and difficulty in swallowing.

　　2, Lhou Syndrome Formula

　　New green tea, mint, Huangbai each 9 grams, 5 grams of borax after roasting, 1 gram of bingpian, ground into a very fine powder and blown into the throat, with the effects of clearing heat and detoxifying, and relieving throat pain. It is mainly used for throat swelling and pain.

　　3, Throat Tea

　　Gancao, Jiegeng, Bohe, Chanyi each 5 grams, one egg white, infused with boiling water and taken, mainly for acute throat pain and difficulty in speaking.

　　Temporarily fasting, placing a gastric tube to continuously reduce gastrointestinal pressure, correcting dehydration, electrolyte imbalance, and acid-base metabolism imbalance. Hypokalemia is often masked by blood concentration and should be noted. After the condition improves for 24 hours, a small amount of liquid can be injected into the gastric tube, and if there is no retention, one can start to eat in small amounts. If there is no improvement, surgery should be performed. For those caused by overeating, it is difficult to aspirate the remnants of the gastric contents through the gastric tube, or there is duodenal obstruction and complications have already occurred, and surgery should also be performed. The surgical method is generally based on the principle of simplicity and effectiveness, such as simple gastric incision and decompression, gastric repair, and gastric fistula surgery. Gastric wall necrosis often occurs below the esophagus and near the gastric fundus near the esophagus, due to the inflammation and edema around the necrotic area and the thin tissue, the mobility of the local tissue is poor. For cases with large areas of necrosis, repair or fistula is futile, and it is advisable to adopt partial resection of the proximal stomach and esophagogastric anastomosis.